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Prevention Planning: Whats Up? FILE: WHATSUP CH SBT 7-24-12 Wayne Munchel - WMunchel@starsinc.com 2011 Wayne Munchel & Hewitt B. Clark

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Whats Up? Prevention Planning Method TIP Model Practices for Improving Outcomes with Youth & Young Adults with EBD Wayne Munchel, LCSW Hewitt B. Rusty Clark, Ph.D., BCBA National Network on Youth Transition

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Types of Risk Behavior/Risk Situations (RB/RS)

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WHATS UP?: Objectives To elicit reasons for change from the YP To promote YPs involvement & investment in their own treatment & support plans To create a safe place for YP to explore making changes without feeling pressure from TF to do the right thing To (begin) instilling a sense of self-efficacy, self-advocacy and self-evaluation.

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Prevention Planning Method WHATS UP? WHATS UP? ~ A Motivational Interviewing (MI) approach to reducing & eliminating risk behaviors & risky situations among youth & young adults (YA) with emotional & behavioral difficulties.

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Why MI for Youth & Young Adults? Powerful process for enhancing YAs engagement, empowerment & for eliciting change Respects autonomy & utilizes value explorations/future focus Brief, informal, flexible applications Many TAY are classic pre-contemplators/ contemplators Consistent w/ TIP Guidelines & Core Competencies

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Transition & Risk Behavior Transition is a time of developmentally normative risk Transition is a time of developmentally normative risk What does this mean?

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What is your concern? How does RB fit in with future plan/values? Ask about good, not so good aspects of RB. Talk about options. See the stage of change. Understand ambivalence. Plan for next steps.

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WHATS UP? Considerations Distinguish between Safety Planning & Prevention Planning To write plan or not if YP wants to, yes When YP refuses? STAY ENGAGED The Prevention PLAN ~ is a fluid ongoing process Learning WHATS UP? requires practice, coaching & feedback Dont stress on the letters ~ keep listening & reflecting

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SODAS YP more clearly in action stage For coaching in more rational/ cognitive process Decision-making re: lower risk behaviors WHATS UP? YP more ambivalent, contemplative For coaching in more emotionally driven behaviors Decision making higher risk behaviors vs.

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The TFs First Task Distinguish yourself from adults w/ more traditional messages WHY? ~ hx of controlling interactions ~ previous exposure to exaggerated drug ed ~ sense of invulnerability ~ coercion by justice system ~ need to establish identity/autonomy Ingersoll, Wagner, Gharib (2000)

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What is your concern? Builds upon foundation of engagement/trust Many ways to start this conversation w/ young people what are yours? Focus on informative details of situations & function of RB Acknowledge common doubts/feelings Use OARS & LISTEN!!!

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Open-ended Questions Affirmations Reflections Summary Statements OARS Miller and Rollnick, (1991)

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Role Play: What is the concern? Training Manual p.12 & 13

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How does concern (RB/RS) fit in w/ Futures Planning/Goals/Values? TIP Guideline: Acknowledge & develop personal choice & responsibility MI principle: Gently develop discrepancies between goals, hopes, values (Dont confront) This step can often inform medical necessity Avoid argumentation and be mindful of righting reflex. Stop, Drop & Roll with Resistance!

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Ask about pros/cons of YPs concern (RB/RS) Express empathy -acknowledge how RB/RS makes sense (Acceptance is not approval) What function does RB/RS serve? Use SODAS format of advantages/disadvantages Normalize ambivalence

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Talk About Options/Elicit Change Talk Include/affirm option of continuing RB What are advantages of change/disadvantages of status quo? Explore incremental/harm reduction changes Only when people feel free to stay the way they are do they feel free to change-Rogers

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Role Play Juan/Juanita: W H A T What is the concern? How does the RB fit with future plan? Ask about pros/cons of RB Talk about options Training Manual p.12 & 13 Juan USE WHATS UP? FORM DURING ROLE-PLAY

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See the Stage of Change? This is an assessment not a question for YP Pre-Contemplation ~ What problem? You/they have the problem! Contemplation ~ Sometimes I think Ill do something about it, but other times, I just go with the flow. Preparation ~ Im starting to think about how I could change, what are the options? How hard would it be? Action ~ Im want this, where do I get started, Ill need help, lets do this thing Maintenance ~ Ive made changes and Im doing OK (man, its hard!) Im worried about screwing up, though.

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Pre-contemplater Educate w/ permission focus on building trust & encouraging self-exploration Strengths Discovery & Needs Assessment

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Contemplater NORMALIZE AMBIVALENCE Help tip the decisional balance scales toward change Encourage evaluation of pros & cons of change (SODAS/Futures Planning)

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Preparer Assist w/ prob solving (SODAS/SCORA), encourage initial small steps, clarify goals (Futures Planning) Identify and explore possible actions, visualize what change would look like, what would be hard? Use Internet & field visits

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Actor Int: NORMALIZE Bolster self-efficacy (In-vivo) Revisit long-term benefits (SODAS) Identify high-risk situations (Prev. Planning)

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Maintainer Discuss coping w/relapse (Prev. Planning) Practice new skills (In-vivo) Review long-term goals (Futures Planning) Plan for follow up Reframe relapse as part of recovery

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Relapse NORMALIZE, evaluate triggers, re-assess motivation & barriers (Futures Planning/SODAS/ Rationales/Prev. Planning/ Strength Discovery)

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Discussion: See the Stage of Change Training Manual p.13

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Understand Ambivalence Summarize options & advantages/disadvantages of change Reframe past unsuccessful attempts at Involve supportive key players as appropriate Express encouragement & hope

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Plan next steps Match step to Stage of Change

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Now you try it! Participant Manual Pg. 12 Form groups of 2 or 3 Designate TF, young person, scribe/observer Ask for help/input from observers Dont stress over which letters youre on Pause at end of WHAT- & ask which stage is portrayed Have fun! Discuss whats difficult/whats easy?

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Valuable Resources on MI MI Website: www.motivationalinterview.org Naar-King, S. & Suarez, M. Motivational Interviewing with Adolescents and Young Adults 2011 John S. Baer and Peggy L Peterson. (Chapter 21). Motivational Interviewing with Adolescents and Young Adults. In Miller, W.R. & Rollnick, S. Motivational Interviewing: Preparing People for Change (2 nd Edition).

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More TIPS for using WhatsUp? Make specific plans when hearing increasing levels of change talk>>>>>commitment talk (Ill try ~ I will) Test the waters: What do you think youll do next? Avoid asking for specific action steps in earlier stages Anticipate changes: How might you go about making changes when you feel ready? What might get in the way? Share experiences: If youd like, I can tell you about some things other YP have tried and has worked for them. What, if anything, would you like to work on next time? Consider: Are you more enthusiastic about change than YP?